Can technology be a change agent for health care?

I was invited to attend a private breakfast with book author, surgeon, and New Yorker contributor Dr. Atul Gawande shortly before Dr. Gawande’s talk at The New Yorker Festival. Over breakfast, Dr. Gawande spoke with IBM executive Dr. Paul Grundy on the future of health care. The event was sponsored by IBM so there was plenty of talk about how technology can and will influence the practice of medicine — from big-data diagnoses and personalized medicine to enhancing doctor-patient communications.

But, to me, the big question Dr. Gawande raised was this: Can technology be a change agent for health care? The inevitable answer is yes, with one important caveat. It’s not the technology that will change the practice of medicine, it’s the doctors who use the technology who will end up changing it. And it won’t come overnight. Many of the most influential doctors practicing medicine today have an antagonistic relationship with computers. Change will only come in a massive way when the under-40 generation takes control.

Under-40s expect technology as impressive as Facebook, Twitter, Kayak, and Tumblr to influence each and every moment of our practice. My generation simply doesn’t know how to live without the Internet. However, we’re not yet leaders and technological decision-makers in our health-care system. Our parents are heads of hospitals, chairwomen of departments, and CTOs of health-care delivery networks. When this generation of boomers retires this decade, we’ll see massive change. It’s not their fault. Technology, the internet, and iPhones simply aren’t in their DNA.

I’m 37-years-old and graduated medical school in 1998, four years after Amazon.com was founded. I had my first computer in 3rd grade — a Commodore 64. Of course it wasn’t connected to the Internet, but I grew up tinkering and exploring and using my imagination to see how I could use computers to make my life easier and more fun. When I couldn’t figure something out on my computer, I quickly realized I couldn’t ask the wisest man I know—my own father. He was absolutely no help, and today at age 65, he’s still no help. He still thinks he’s going to break the Internet. Computers stress his generation out.

I see this every day in my company. We’ve built an online platform that allows patients to message our doctors and have an online conversation to either treat medical problems or refer to the most appropriate healthcare professional in the neighborhood. I’ve hired two generations of doctors — one from my parents’ generation and one from my own. The differences are striking. One feels right at home, empowered and enabled, and the other thinks she’s going to break something. The older physician still loves what she does, and enjoys learning out of curiosity, but computers just aren’t hard-wired into her brain like the younger one.

I speak to medical students on a regular basis about creativity in health care and I open up every conversation with one question: “Who is the youngest one here?” Some precocious kid always raises her hand and says “I was born in 1992.” She’s just a few years older than Amazon, Facebook and the iPhone. Leaving her iPhone at home is anxiety-provoking and socially isolating for her. In just a few years, she’ll be the resident treating the current health-care leaderships’ broken hips in the ER. If she doesn’t have her smartphone with its suite of professional tools that enable her to practice medicine as effectively as purchasing a plane ticket or keeping up with her friends and family, quite simply, she’ll feel anxious and lost.

It’s been said that the Internet is the greatest generational divide since rock-n-roll. My grandparents’ generation didn’t know what to do with the Beatles. My parents didn’t know what to do with the Internet. My generation doesn’t know what to do without the Internet. There’s a sea change coming in health care. It’s not due to amazing new technological tools. It’s due to a new guard of health-care professionals providing new forms of leadership with new behaviors and expectations, demanding the use of familiar tools in their everyday practice. As a physician, I couldn’t be more excited about ushering in these new technologies to help doctors be better doctors and patients be better patients.

Can technology be a change agent for health care? 22 comments

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CPO_C_Ryback

What will the Web do about self-administered medical problems — smoking, dope, booze, over-eating and “wild living?”

Not much, IMHO. Just look at healthcare(dot)gov.

Low standards, high medical costs. Res ipsa.

May Wright

“Many of the most influential doctors practicing medicine today have
an antagonistic relationship with computers. Change will only come in a massive way when the under-40 generation takes control.

“When this generation of boomers retires this decade, we’ll see massive change. It’s not their fault. Technology, the internet, and iPhones simply aren’t in their DNA.”

/ / /

Excuse me? Steve Jobs and Bill Gates were born in 1955. That places them squarely into “Boomer” territory. Everyone over 40 is a technophobic Luddite dinosaur? Really?

Your smug sense of superiority and your implication that “everything will be better once we get rid of all those stupid old farts” is really embarrassing.

alex

Haha.

By the way, Eric Topol, an “old” cardiologist at Scripps is fully embracing technology…. running around the hospital with novel iPhone apps, widgets, and gadgets in an effort to use technology to “improve care” and lower health cost.

Finally, you’re giving the post 1990 pre-meds and their generation way too much credit. They’re the “buy a new iPhone every 2 years” and all “applications are plug and play” generation.

GT

BOOM.

Dr. Cory Annis

As a 56 Med/Peds doc, I thought tech would get the better of me. Then at 50, I drank the Apple Koolaid and discovered the truth…I don’t hate technology…I hate crappy technology that isn’t designed with me in mind! Instead of early retirement I have expanded my bricks and mortar office into the virtual world, much to the delight of my patients. NOW I find that I am waiting on the tech world to catch up with ME!

Take my (3rd) EMR …

PLEASE!

southerndoc1

“Leaving her iPhone at home is anxiety-provoking and socially isolating for her. In just a few years, she’ll be the resident treating the current health-care leaderships’ broken hips in the ER. If she doesn’t have her smartphone with its suite of professional tools that enable her to practice medicine as effectively as purchasing a plane ticket or keeping up with her friends and family, quite simply, she’ll feel anxious and lost.”
And this is a positive development?

http://www.waynecaswell.com Wayne Caswell

I don’t think she’ll panic, but she may be a lot less effective. That’s because instead of tapping the collective world experience of a particular disease and the tools to help personalize a treatment plan, she’ll have to rely on the 4 cases she’s seen personally and pick a more generic plan.

Dr. Drake Ramoray

This article is a gross oversimplificaiton of technology and medicine. Physician resistant to technology is not because we are resistant to technology. Physicans resist technology that is forced up us by administrative fiat. Take our EMR. It costs thousands of dollars up front, costs also 1200 ish a month in service fees, is slow, cumberson, has a crappy interface, and slows me down. It does not provide any meaningful benefit for my patient care and I actually probably take care of less patient’s because of it. I am resistant to EMR mandates and hate meaningful use.

On the other hand, my practice just replaced a 12 year old ultrasound machine. The new machine is portable (can move it to the patient if that is more convenient), has much better images, can store the images on our server that can be viewed from any computer in the practice, generates clean typed written reports based on my measurements and input characteristtics, and actually lets me get my job done fast because I don’t have to dictate an ultrasound note. I can actually do about 20% more ultrasounds on a given day. Becuase of the new ultrasound machine I”m actually able to do same day ultrasounds now when it’s clinically indicated.

The EMR is an example of technology forced upon physicians by federal dictat and crony capitalism. It does nothing to improve my patient care or the practice of medicine, and actually slows me down so not only do I lose money in vendor fees but actually struggle to see the same number of patients. It is also becoming nigh mandatory.

My ultrasound was a product developed for a specific purpose without dictat,mandates, or crony capitalism. There were no minimal requirements, meanigful use measurements, or features mandated by some beancounter who doesn’t know the first thing about medicine. I embrace my new ultrasound and the computer technology it brings with it. It provides improved patient care and doesn’t cost me an arm and a leg. My EMR on the other hand, well let’s just say my small rural practice is considering dumpint it because we are fairly certain we won’t be able to meet meaningful use stage 2.

buzzkillerjsmith

So your point is that good tech is good, but bad tech is bad, and it is important to see the difference between good tech and bad tech.

I realize, Dr. D., that you are an intelligent man and should not be spoken to as if you are an idiot. Hence my first paragraph was addressed not to you but rather to persons in medical information technology.

http://www.waynecaswell.com Wayne Caswell

Your EMR example reminds me that docs and hospitals seem to have different objectives, and one is purely profit driven, causing them to choose EMR systems that don’t communicate with other EMR systems. That way they can charge for that test all over again, or discourage patients from going to competitors since they’d have to have the tests done again, or pay a hefty fee to get paper versions of the medical record photocopied.

http://www.davisliumd.blogspot.com Davis Liu, MD

Though I appreciate Jay’s comments, technology is a tool and alone won’t change health care. We know outside of health care, technology is used by a variety of people of different ages. The difficulty in adoption within health care can’t simply be due to a generational issue. This is too simplistic of a conclusion. Instead might it be due to the circumstances many doctors find themselves today? Many are in one to three doctor group practices without significant resources that an academic medical center or very large multispecialty medical group has – like a Mayo or Cleveland Clinic – to adopt technology. Might the reason for discrepancy be the nature of the fragmentation in health care? There are no large national organizations in health care at the same scale of airlines or financial services where technology is used widely and consistently by tens of thousands of people daily. Might it be these circumstances that exist be the reasons that doctors and health care (particularly the delivery system aspect) did not adopt technology widely as other industries?

Without the leadership skills to lead change, those in the under 40 generation may find changing the existing system is not quite as easy as it sounds. Many under 40 have opted out of the current system because they (we) are fortunate enough to live in a time precisely where tools are available now where people are build things, be heard, get funded more quickly and more cheaply than a generation ago. Had they simply been born 10 years earlier, they would not have been able to do so. Creating and leading a start-up is different than changing an existing organization from inside out. If we use a “technology” example like Peter Pronovost’s 5 step checklist to decrease central line infections, we learn that despite its simplicity and stunning success to eliminate central line infections, adoption is variable among hospitals across the country. How much simpler could it be? http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande?currentPage=all

It wasn’t clear in the past, but it now appears even Gawande is increasingly aware of this issue. It isn’t just checklists, workflows (ala Cheesecake Factory) that will make health care better. It is more than that. It is likely that whatever technology or tools we have available that they may change the world. That might, however, not be enough. To get the level of consistency, high reliability, and adoption needed across entire industries like health are we need scale, organizational structure and leadership. http://www.newyorker.com/reporting/2013/07/29/130729fa_fact_gawande?currentPage=all

Yes, technology will help change health care, but not by itself.

guest

In fact, the entire point of Dr. Gawande’s very good New Yorker article is that we will only be able to bring about change in healthcare the old-fashioned way; by developing personal relationships with people, listening to them to hear their ideas about the barriers for change, and then helping them overcome those barriers. Not a computer anywhere in sight in the interactions that he described; the most technology involved was a cell phone.

http://onhealthtech.blogspot.com Margalit Gur-Arie

What does the iPhone, or Amazon, have to do with health care? What does personal use of little computers in your pocket, have to do with medicine? Or chemistry or biology or physics or any type of scientific progress for that matter?

There are no short cuts. There never were. What will change health care is what has been changing health care since pretty much forever: scientific research. Sure, some of the research is greatly aided by computers, not pocket toy ones, big ones like IBM, which is probably why they sponsored the event, but in the end, health care will not change in any significant way until the next scientific breakthrough is achieved.

So maybe instead of funding the one thousand, three hundred and forty seventh, incrementally useless “engagement platform”, we should pool our money and fund the NIH.

buzzkillerjsmith

Jay, do you have any understanding of this at all? Technology, generally defined, has been the agent of change for the entire human race over over many, many thousands of years. Yet your definition is farting around with computers.

Consider the Roman aqueducts, consider the invention of coinage, consider the longbow. Consider the musket and the rifle, those bringers of meat, the invention of steel, Jenner’s invention of immunization. Consider the cotton gin, internal combustion, the railroads, telephony, antibiotics, the last century’s understand of macroeconomics. Yet your definition is having doctors fart around with computers.

You’re 37 years old. What have you learned? Not enough, I say, except perhaps how to advance your own career.

Jim Miller

His generation are the computer technology /consumers/. It was the boomers he wants to kill off who were the /creators/ of that selfsame computer technology.
If he were a child, we’d have to forgive him, but 37 is a bit old to be that stupid and self-centered.

guest

Oh, dear, I am afraid you totally lost me when you described Facebook, twitter, tumblr as “impressive.”

What you see as “impressive,” many others see as forces that are conducive to a much shallower style of thinking and interacting that cannot possibly be a positive force in medical work.

And a resident who feels “anxious and lost” and socially isolated without her iPhone? Res ipsa loquitur.

http://www.zdoggmd.com ZDoggMD

Hey, you’re not the only one who can name drop. I too was important enough to be invited to a private breakfast with a major thought leader. His name is Captain Crunch, perhaps you’ve heard of him?

guest

Apparently your youth and supposedly superior familiarity with technology have not provided you with the ability to realize that anyone who can click on a link and explore a website could figure out which of your doctors you are referring to so disrespectfully in your fifth paragraph above. How do you think that makes her feel? Nice management skillz.

whoknows

Now that’s frickin’ cool. What airport and how did you meet him? I have a T shirt as a Dr. Who fan ” You never Forget your First Doctor”

whoknows

Talking about Dr. Who is much more interesting.

lol

azmd

“..thinks he’s going to break the internet?”

What, exactly does this mean? Is it some sort of Brooklyn-hipster meme?

I know dozens and dozens of people over 40 (thank God), and not a single one of them is afraid they are going to break the Internet. In fact, my 78 year old mother appears to have an internet addiction and we all wish she were just a little more afraid of the internet…

Perhaps Dr. Parkinson does not mean “afraid of the internet,” but rather “fails to acknowledge the supreme value of the many vapid social media and entertainment opportunities that seem to be proliferating like bedbugs, and that contribute to all of us walking around all day with our faces buried in a smartphone?”

Also, if a resident cannot treat a broken hip without a smartphone, then how is she any different from a non-doctor?

http://www.zdoggmd.com ZDoggMD

WOW! You need to write a piece for Kevin about how under-40-year-olds are afraid they’d “break the Tardis” if they tried to manipulate the space-time continuum, whereas us 40 and overs are hard wired to be Time Lords.